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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Dissolution )of the Marriage of ))) and)) ,))CASE NO. Husband and Wife. ) )PETITION FOR DISSOLUTIONOF MARRIAGEWe consent to the court's jurisdiction and request a decree of dissolution of marriage pursuant to AS 25.24.200-.260. An incompatibility of temperament has caused the irremediable breakdown of our marriage. We agree that this petition constitutes the entire agreement between us. We understand that agreements not written in this petition or its attachments will not be enforceable.I.INFORMATION ABOUT PETITIONERSA.Children1. Are there any children under age 19 who were born to the wife or adopted during the time you were married? Yes No 2. Is the wife now pregnant? Yes No If you checked "yes" in response to either of the above questions, you should not use this form. You must use Packet No. 1 unless the paternity of the husband has been legally disestablished. (If it has been, attach to this petition a copy of the documentation disestablishing paternity.)B. Husband1. Length of residence in Alaska: 2. Residence address: (street address) (city)(state)(ZIP)3. Home phone: 4. Mailing address: (box or street number) (city)(state)(ZIP)5. Occupation: Work phone: 6. Social Security No.* C. Wife1. Length of residence in Alaska: 2. Residence address: (street address) (city)(state)(ZIP)3. Home phone: 4. Mailing address: (box or street number) (city)(state)(ZIP)5. Occupation: Work phone: 6. Social Security No.* Husband’s Signature Wife’s Signature*It is mandatory that you provide your social security number. AS 25.24.210(e)(12), AS 18.50.280(a) & 42 USC 666 (a)(13)Page 1 of 7DR-100 (7/02)(cs) AS 25.24.200-.260PETITON FOR DISSOLUTION OF MARRIAGE (NO CHILDREN) Civil Rule 90.1(a) D.Date and place of marriage: E. Does either spouse require medical care or treatment? Yes No If yes, state which spouse and describe the care or treatment required: Is either spouse covered by health insurance (through an employer or otherwise)? Yes No If yes, state which spouse and the amount paid for the insurance by the spouse or spouses: F. Have any of the following been issued or filed during the marriage by or regarding either spouse as defendant, participant, or respondent:1. a criminal charge of a crime involving domestic violence;2. a domestic violence protective order under AS 18.66.100 - 18.66.180;3. injunctive relief against domestic violence under former AS 25.35.010 or 25.35.020; or4. a domestic violence protective order issued in another jurisdiction and filed with the court in this state under AS 18.66.140? Yes NoIf yes, describe: Has there been any domestic violence during the marriage (whether or not a complaint was filed)? Yes No G.Has either spouse received advice from legal counsel about a divorce or dissolution? Yes No If yes, state which spouse(s): Is either spouse represented by legal counsel? Yes No If yes, state which spouse(s): Husband's Signature Wife's SignaturePage 2 of 7DR-100 (7/02)(cs) AS 25.24.200-.260PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN) Civil Rule 90.1(a) II.FINANCIAL INFORMATION AND AGREEMENT OF PETITIONERSEach party must attach a copy of his or her most recent federal tax return and most recent pay stubs to verify income and deductions.The following income and deductions are monthly yearly. A.Gross Income (Do not list ATAP or SSI below.)Husband WifeGross wages $ $ Value of employer-providedhousing/food/etc. $ $ Unemployment compensation $ $ Permanent fund dividend $ $ Other: $ $ $ $ $ $ $ $ B. Deductions:Federal income tax $ $ Social security tax $ $ Medicare tax $ $ Employment security tax $ $ Mandatory retirement deductions $ $ Mandatory union dues $ $ Other mandatory deductions (Specify): $ $ $ $ $ $ $ $ Child support/alimony ordered in othercases and currently being paid $ $ C. Net IncomeTOTAL INCOME from section A $ $ TOTAL DEDUCTIONS from section B $ $ Subtract deductions from income to getHusband's Signature Wife's SignaturePage 3 of 7DR-100 (7/02)(cs) AS 25.24.200-.260PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN) Civil Rule 90.1(a)TOTAL INCOME$ $ TOTAL DEDUCTIONS $ $ NET INCOME $ $ D.Monthly Expenses HusbandWifeHousing & Utilities $ $ Food $ $ Transportation $ $ Medical $ $ Other $ $ $ $ $ $ TOTAL $ $ E. Assets[Describe your property and its value. Then check the boxes showing whether it was acquired during the marriage, who owns it now and to whom you want it awarded.]1.Do you have a written community property agreement or a community property trust under Alaska law (AS 34.77)? Yes No Be sure to include any community property in the lists below.Acquired To BeDuringPresently Awarded2.Real Property (land & buildings). MarriageOwned By ToLegal description required. Value $ $ $ $ $ $ $ $ $ 3. Motor Vehicles (include make,model, vehicle ID/serial number and AcquiredTo Belicense number of each vehicle, DuringPresently Awardedmobile home, ATV, boat and snow MarriageOwned By Tomachine) Value $ $ $ $ $ $ $ $ $ Husband's Signature Wife's SignaturePage 4 of 7DR-100 (7/02)(cs) AS 25.24.200-.260PETITON FOR DISSOLUTION OF MARRIAGE (NO CHILDREN) Civil Rule 90.1(a)yesnoHWJTHWJTyesnoHWJTHWJT 4.Other Personal Property (householdfurnishings, appliances, jewelry, AcquiredTo Becomputers, guns, tools, bank DuringPresently Awardedaccounts, etc.) MarriageOwned By ToValue $ $ $ $ $ $ $ $ $ 5. Retirement Benefits. Neither spouse has earned retirement or military pension benefits during the marriage.Our agreement about the distribution of retirement or military pension benefits is attached. If this agreement is not accepted by the retirement plan administrator as a qualified domestic relations order, we agree that the court, upon motion by a party, may make any necessary corrections. We agree any such court-ordered modifications will be effective retroactive to the date of the original dissolution decree.A copy of the present value statement from the plan administrator for each retirement account is attached.6.Title transfer. All transactions necessary to effect any transfers required by the above agreements will be completed by .F.Debts[List to whom each debt is owed and the amount owed. Then check the boxes showing whether the debt was incurred during the marriage, who now owes the debt and who you agree will be responsible for paying it.]IncurredDuring Presently To BeMarriageOwed By Paid ByOwed To Amount $ $ $ $ $ $ $ $ $ We believe the above division of assets and debts is fair and just.Husband's Signature Wife's SignaturePage 5 of 7DR-100 (7/02)(cs) AS 25.24.200-.260PETITION FOR DISSOLUTION OF MARRIAGE (NO CHILDREN) Civil Rule 90.1(a)yesnoHWJTHWJTyesnoHWJTHWJT III.SPOUSAL MAINTENANCE (ALIMONY): $ per month to be paid by Husband Wife, beginning , until or until the recipient dies or remarries.IV.RESTORATION OR CHANGE OF NAME. Restoration. Petitioner wants a prior name restored as follows: (Print full names clearly.) From: To: (wife's current full name) (wife's prior full name)From: To: (husband's current full name) (husband's prior full name) Change. [Before checking this box, it is important to read pages 10-11 of the instructions about publication costs and hearing delay.] Petitioner wants to take and be legally(current legal name)known by a new name, which is The reasons for this request for a change of name are: Petitioner seeks this name change for personal reasons and not to avoid judgments, debts, obligations, or to defraud any person. The reasons stated are consistent with the public interest.V.OTHER AGREEMENTS. Husband's Signature Wife's SignaturePage 6 of 7DR-100 (7/02)(cs) AS 25.24.200-.260PETITION FOR DISSOLUTION OF MARRIAGE Civil Rule 90.1(a) X. SIGNATURES AND VERIFICATIONS.Do not sign until this petition has been completely filled out. Each signature on this page must be individually notarized. Verification I say on oath or affirm under penalty of perjury that I have read the foregoing petition and believe all statements made in the petition are true. I further certify that my signature is voluntary and not the result of fear, threat, coercion or restraint. I further state that this petition contains the entire agreement between my spouse and myself.Husband's Signature Wife's Signature Date DateSubscribed and sworn to or affirmed before me atSubsc rib ed a n d s w orn t o o r a ffir m ed b efo re m e a t , A la sk a, o n , A la sk a, o n . . C le rk o f C ourt, N ota ry P ublic o r o th er p ers o n Cle rk o f C ourt, N ota ry P ublic o r o th er p ers o nau th oriz e d t o a d m in is te r o ath s. au th oriz ed t o a d m in is te r o ath s.M y c o m m is sio n e x pir e s: My c o m mis sio n e x pir e s: (S E A L) (S E A L)Pag e 7 o f 7D R-1 00 ( 7 /0 2)(c s) AS 2 5.2 4.2 00-.2 60P E T IT IO N F O R D IS S O LU TIO N O F M ARRIA GE ( N O C H IL D REN ) Civ il R ule 9 0.1 (a )